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CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: ��✓ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES 'I NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ,/U <br /> DESCRIPTION OF WORK: o <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 0 —lO <br /> CrTYLeSTATE ZIP <br /> OWNER PHONE: Y �j OWNER EMAIL: <br /> CONTRACTOR NAME: c— <br /> CONTRACTOR ADDRESS: STREET / <br /> CITY �/V1C��,�-_._�,�=�j STATE ZIP —2— <br /> CONTRACTOR PHONE.3 jCONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): c CITY OF EVERETT BUSINESS LIC.#(REQUIRED)6L/ �� <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 31 _'310 _7 <br /> CONTACT EMAIL: <br /> AGREEMENT.:Thereby certify that/have read and examined this application and know the same to be trueAd correct All provisions of laws and ordinances governing this <br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That/am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> 7 <br /> Owner/ fionze gen ignature Date (Revised 90/92/2095) <br />